Sunday, November 9, 2008

Neuropathy management and market building


Shakespeare, the bard of Avon has said, "There is a tide in the affairs of men, which when taken at the flood, leads to a fortune". These timeless words reflect the importance of timing in creating wealth. All said and done, most of pharmaceutical and healthcare organizations, are in the business of health for wealth, while concomitantly achieving social goals. Thus, it is of utmost importance to latch on to emerging trends early and go along with the tide to gain a fortune.

Today, reflecting on diabetes and diabetic complications (NOV 14th is WORLD DIABETES DAY), one does realize that a small pot of gold awaits the patient pharma marketing warriors riding on the neuropathy disease trend.

The march of diabetes continues unabated

As per the Nov 2008 issue of Reader's Digest,, there are about 230 million diabetics in the world, 41 million (4.10 crores) are in India. In fact, our country, India, is called the diabetes capital of the world. By 2025 the projections are that there will be 70 million diabetics in India, every fifth diabetic in the world by 2025, will be an Indian.

Type 1.5 diabetes

Newer research insights have lead to interesting facets of diabetes, so much so that diabetes researchers have now observed a new class of diabetics (Type 1 1/2!) OR (TYPE 1.5). As such, there are two major classes of diabetics: Type 1 (those that are dependent on insulin) and Type 2 (who are on diet control, lifestyle management, and oral antidiabetics). 70% to 80% of Indian diabetics are Type 2. Type 1.5 diabetics are non insulin dependent, are not overweight, and do not show significant insulin resistance.

A research study says, weight loss of 5% to 7%, exercising for 30 minutes, 5 times a day, lowers the risk of developing diabetes by 60% - this goes to show that sedentary lifestyles are the main cause of increasing diabetes in India.

Dr. Abdul Kalam, our Ex President of India, in his book India 2020 says, on page 231, about 5 to 10% of Indian population suffers from diabetes.


The most common complication in diabetics is neuropathy, ie., disease of the nerves. The Indian Practitioner, Oct 2008,, says about 19% to 28% of diabetics suffer neuropathy. Neuropathic pain is said to affect 16% of diabetics.

Back of the envelope calculations

Let us say there are 50 million diabetics in India ie., 5 crores (1 million = 10 lakhs, 100 lakhs = 1 crore). This means there are 1.4 crore diabetics suffering neuropathy (@ 28%), and 80 lakh diabetics suffer neuropathic pain (@ 16%).

Diabetes is not the only cause of neuropathy, - HIV, herpes, toxins, alcohol, and cancer chemotherapy also cause neuropathy.

In the US, neuropathic pain management business is 2.6 billion USD. Lyrica (pregabalin) from Pfizer, and Cymbalta (duloxetine) from Eli Lilly, are the mainstay drugs, their patents will expire in 2013 & 2018, respectively. In India, gabapentin is used frequently for neuropathic pain management.

Market development and Management of neuropathy

Neuropathy, particularly diabetic neuropathy, is not well understood. A lot of research is on. To manage this condition with drug treatment - antidepressants too are used. Regular type of NSAIDs (ie., non steroidal anti inflammatory drugs like diclofenac and combination drugs) are also clinically attempted, and morphine analogues are used clinically.

Dietary supplements/drugs like alpha lipoic acid, and methylcobalamin have good scope in diabetic neuropathy management as per clinical studies.

However, a lot of new drugs are in the pipeline of various companies targeting neuropathy.

One of the major aspects of neuropathy is that this irreversible condition is frequently under-diagnosed. A LOT OF SOCIAL GOOD AND COMMERCIAL GAIN DEPENDS ON A MARKET BUILDING APPROACH BY PHARMA AND HEALTHCARE MARKETERS.

Diagnosis camps: The camp approach (camps sponsored by pharma companies) is vital to create vibrations in the market, increased consciousness, and increase the no. of diagnosed cases. For eg., osteoporosis was a not so-popular indication in clinical practice a few years back. When pharma marketers organized a no. of free osteoporosis diagnosis and treatment camps (with the aid of DEXA or DXA machines), the market bloomed, and a lot of social good was achieved. Similar success followed the strategic camps for hepatitis B vaccination (by the way Gardasil the cervical cancer vaccine has been launched on a very low note in India - without much publicity, wonder why?).

Thus, consistently organizing neuropathy detection camps particularly for diabetics will usher in a new age of clinical management of neuropathy in India. To detect neuropathy particularly in diabetics, an instrument called vibrometer is used, where the vibration perception threshold (VPT) is measured.

Creating the buzz is vital: It will certainly not suffice if the camps alone are conducted. A buzz is required in the public media and through posters and other print materials at healthcare points (clinics, chemists, diagnostic labs, gyms and Yoga centers, and other healthcare service providers). ONE SHOULD ENGAGE THE DOCTORS AND PATIENTS ON THIS ISSUE FOR THE BUZZ.

One interesting approach is to use the mobile to create the buzz for neuropathy:

For eg., let us say 500 doctors (spread across India) are identified to participate in a series of neuropathy diagnosis camps. As per this approach, each of these doctors will receive daily sms updates on how the camps are progressing India wide. For eg., one message can be Dr. Manjunath of Bangalore has had excellent response to his neuropathy diagnosis camp, 25 new cases detected with mild neuropathy on first day, 14 cases of moderate neuropathy detected. Another sms message can be Dr. Venkat of Chennai is very happy with Brand A benefits in mild neuropathy - good response for Brand A seen within 24 hours of therapy in 50% of patients. ONE MORE MESSAGE CAN BE: Dr. Singh's Delhi diabetic neuropathic camp inaugurated today morning by the Chief Minister of Punjab, 500 patients attend camp on first day .... SO ON.

Today, like Shakespeare has advised, one has to ride on the tides - to gain a fortune. Neuropathy is an emerging area of clinical management with significant commercial appeal.

Thanks for reading this blogpost, please feel free to scroll down and read all other blogposts, click on older posts wherever required.


LG said...

Wonderful post and you write very well. I had this desire to start a blog on clinical trials. Your blog is now kinda inspiration to me. I have done my M Pharma too from BIT Ranchi. Presently in Singapore working in the area of Clinical Research.

Sunil S Chiplunkar said...